Responsibility for Tracking 100-Day Benefit Sample Clauses

Responsibility for Tracking 100-Day Benefit. ‌ The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility Subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services, using DHS 4461A. The STATE will verify the information documented by the MCO.
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Responsibility for Tracking 100-Day Benefit. Non-SNP.‌ The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility Subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services and the STATE will verify the information documented by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include but is not limited to the following: • Provider claims submitted to the MCO for Nursing Facility services; • Documentation of Medicare covered services, including coinsurance claims for Medicare covered days; • Internal patient account summaries; • Service Authorizations if used by the MCO; • Claim denials for any days billed after the MCO’S 100-day benefit period has ended; or • Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility.
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Responsibility for Tracking 100-Day Benefit. Non-SNP.‌ The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility Subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services and the STATE will verify the information documented by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include but is not limited to the following:  Provider claims submitted to the MCO for Nursing Facility services;  Documentation of Medicare covered services, including coinsurance claims for Medicare covered days;  Internal patient account summaries;  Service Authorizations if used by the MCO;  Claim denials for any days billed after the MCO’S 100-day benefit period has ended; or  Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility. 4.15.6 Responsibility for Payment of Medical Assistance NF Days, SNBC-SNP and Non-SNP.‌ After the 100-day benefit period is expended for SNBC, the STATE shall assume responsibility for Medical Assistance Nursing Facility Days. 4.15.7 180-Day Separation Period for SNBC-SNP and Non-SNP.‌ Continuous Separation Period. (1) If the MCO has already been liable for 100 days of SNF/NF services, then the one hundred eighty (180) day Separation Period is defined as one hundred eighty (180) consecutive Institutional or community days after the MCO has already been liable for 100 days of SNF/NF services. In either case, after this separation period has expired, the MCO shall be liable for a new, distinct 100-day SNF/NF benefit period for any Enrollee who is still community on the last day of the separation period. If an Enrollee becomes institutionalized prior to the end of the separation period, no new SNF/NF Benefit Period is applied. (2) If the MCO has not previously had liability for SNF/NF services for an Enrollee and the Enrollee leaves the NF, there is no separation period and the MCO will be assigned NF liabili...
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Responsibility for Tracking 100-Day Benefit. The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services and the STATE will verify the information documented by the MCO. Acceptable documentation shall include but is not limited to the following:‌ (A) Provider claims submitted to the MCO for Nursing Facility services; (B) Documentation of Medicare covered services, including coinsurance claims for Medicare covered days; (C) Internal patient account summaries; (D) Service Authorizations if used by the MCO; (E) Claim denials for any days billed after the MCO’S 100-day Benefit Period has ended; or (F) Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility.
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Related to Responsibility for Tracking 100-Day Benefit

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